2 2012 Physician Quality -Medicare EHR Incentive Pilot Participation Eligible professionals who seek to participate in the Physician Quality - Medicare EHR Incentive Pilot must also participate in the Physician Quality Reporting System through submission of specific 2012 Physician Quality EHR measures. See Appendix A for a list of the specific measures. By submitting specific Physician Quality EHR Measures through the Pilot, eligible professionals can submit data on the same sample of beneficiaries through their Office of the National Coordinator for Health Information Technology (ONC)- certified EHR system to meet the core objective for reporting CQMs for the Medicare EHR Incentive Program and meet the requirements for satisfactory reporting under the Physician Quality for the 2012 program year. Eligible professionals participating in the Physician Quality -Medicare EHR Incentive Pilot are still required to report the other meaningful use objectives through the Medicare and Medicaid EHR Incentive Programs Registration and Attestation System. Eligible professionals who wish to participate in the Physician Quality Reporting System-Medicare EHR Incentive Pilot must indicate within the EHR Incentive Program Registration and Attestation System their intent to fulfill the meaningful use objective of reporting CQMs through participation in the Pilot. Eligible professionals participating in the Physician Quality -Medicare EHR Incentive Pilot are required to report CQMs based on a full calendar year (January 1 December 31), and submit required data to CMS by February 28, 2013, to allow alignment with the Physician Quality. Eligible professionals wishing to participate in the Physician Quality - Medicare EHR Incentive Program Pilot should be familiar with the specific completion dates of the other components of the Medicare EHR Incentive Program. Eligible professionals using the direct EHR-based reporting submission method who are unable to report the three core measures and the three alternate core measures as well as any of the remaining 38 measures as a result of not having any patients in the denominator are not permitted to participate in the Physician Quality -Medicare EHR Incentive Pilot. 2

3 2012 Physician Quality -Medicare EHR Incentive Pilot Submission Methods To participate in the Physician Quality -Medicare EHR Incentive Pilot, eligible professionals must electronically report CQM results via one of the following methods: Use a Physician Quality Qualified EHR Data Submission Vendor to: Submit calculated/aggregate CQM results (in an Extensible Markup Language [XML] file) from the eligible professional s ONC-certified EHR to CMS on the eligible professional s behalf (required to satisfy the CQM requirements for the EHR Incentive Program), and Submit the same CQM data at an individual patient level (in the Quality Reporting Data Architecture [QRDA] Category 1 format) using data from the eligible professional s Physician Quality qualified EHR system (required to satisfy the requirements for the Physician Quality ). Use Direct EHR-Based Reporting to: Submit CQM data at an individual patient level directly from an ONC-certified, Physician Quality qualified EHR system in the QRDA Category 1 format (required to satisfy the CQM requirements for the EHR Incentive Program and qualify for an incentive for the Physician Quality ). CMS will then calculate CQM results using a uniform calculation process. For information about how to report both the Physician Quality and the Physician Quality -Medicare EHR Incentive Pilot via the EHR-based reporting option, refer to the 2012 Physician Quality Decision Tree at AlternativeReportingMechanisms.asp on the CMS website. Questions? See Appendix B for a list of Resources/Key Terms. 3

6 Table 3. Additional Measures (cont.) Physician Quality National Quality Forum (NQF) Measure Title Appropriate Testing for Children with Pharyngitis Breast Cancer: Hormonal Therapy for Stage IC IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low-Risk Prostate Cancer Patients Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older Preventive Care and Screening: Screening Mammography Preventive Care and Screening: Colorectal Cancer Screening Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient Diabetes Mellitus: Urine Screening for Microalbumin or Medical Attention for Nephropathy in Diabetic Patients Diabetes Mellitus: Foot Exam Coronary Artery Disease (CAD): Lipid Control 200* 0084 Heart Failure: Warfarin Therapy for Patients with Atrial Fibrillation * CMS suggests eligible professionals participating in the Medicare and Medicaid EHR Incentive Programs not select NQF 0084: Heart Failure: Warfarin Therapy for Patients with Atrial Fibrillation as one of their additional CQMs for meaningful use. As there are other Food and Drug Administration (FDA)-approved medications available for use as an anticoagulant, CMS suggests this measure not be selected as one of the measures reported for the CQM objective. CMS does not expect eligible professionals to change their certified EHR systems or purchase another system to replace this measure. Eligible professionals may continue to report NQF 0084 for the program years if their certified EHR system uses a module that is only certified for nine CQMs with this measure included as one of the nine. 6

9 Key Terms Attestation Medicare eligible professionals, eligible hospitals, and CAHs will have to demonstrate meaningful use through CMS web-based Registration and Attestation System. In the Medicare & Medicaid EHR Incentive Programs Registration and Attestation System, providers will fill in numerators and denominators for the meaningful use objectives and clinical quality measures, indicate if they qualify for exclusions to specific objectives, and legally attest that they have successfully demonstrated meaningful use. A complete EHR system will provide a report of the numerators, denominators, and other information. Providers then will need to enter that data into the online Attestation System. They will qualify for a Medicare EHR incentive payment upon completing a successful online submission through the Attestation System. After they submit their results, they immediately will see a summary of their attestation and if it was successful. Certified EHR Technology The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology. Standards, implementation specifications, and certification criteria for EHR technology have been adopted by the Secretary of the Department of Health and Human Services (HHS). EHR technology must be tested and certified by an ONC Authorized Testing and Certification Body (ATCB) for a provider to qualify for EHR incentive payments. For more information about ONC-certified EHR technology, visit on the CMS website. Clinical Quality Measure CQMs are based on specific evidence-based practices shown to give the best results to the most people. To demonstrate meaningful use successfully, eligible professionals, eligible hospitals, and Critical Access Hospitals (CAHs) are required also to report CQMs specific to eligible professionals or eligible hospitals and CAHs. Health Information Technology for Economic and Clinical Health (HITECH) Act The American Recovery and Reinvestment Act of 2009 (ARRA) was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Subtitle D of the HITECH Act, part of ARRA, addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of Health Insurance Portability and Accountability Act (HIPAA) rules. For more information about the HITECH Act, visit on the CMS website. Meaningful Use ARRA specifies three main components of meaningful use: 1) The use of certified EHR technology in a meaningful manner, such as electronic prescribing; 2) the use of certified EHR technology for electronic exchange of health information to improve quality of health care; and 3) the use of certified EHR technology to submit clinical quality and other measures. Simply put, meaningful use means providers need to show they are using certified EHR technology in ways that can be measured significantly in quality and in quantity. For more information about the Medicare and Medicaid EHR Incentive Programs, visit on the CMS website. 9

10 This fact sheet was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. This fact sheet was prepared as a service to the public and is not intended to grant rights or impose obligations. This fact sheet may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. The Medicare Learning Network (MLN), a registered trademark of CMS, is the brand name for official CMS educational products and information for Medicare Fee-For-Service Providers. For additional information, visit the MLN s web page at on the CMS website. Your feedback is important to us and we use your suggestions to help us improve our educational products, services and activities and to develop products, services and activities that better meet your educational needs. To evaluate Medicare Learning Network (MLN) products, services and activities you have participated in, received, or downloaded, please go to and click on the link called MLN Opinion Page in the left-hand menu and follow the instructions. Please send your suggestions related to MLN product topics or formats to R Official CMS Information for Medicare Fee-For-Service Providers 10

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